Acute Respiratory Distress Syndrome (ARDS) is a life-threatening lung injury for which early diagnosis and evidence-based treatment can improve patient outcomes. Chest X-rays (CXRs) play a crucial role in the identification of ARDS; however, their interpretation can be difficult due to non-specific radiological features, uncertainty in disease staging, and inter-rater variability among clinical experts, thus leading to prominent label noise issues. To address these challenges, this study proposes a novel approach that leverages label uncertainty from multiple annotators to enhance ARDS detection in CXR images. Label uncertainty information is encoded and supplied to the model as privileged information, a form of information exclusively available during the training stage and not during inference. By incorporating the Transfer and Marginalized (TRAM) network and effective knowledge transfer mechanisms, the detection model achieved a mean testing AUROC of 0.850, an AUPRC of 0.868, and an F1 score of 0.797. After removing equivocal testing cases, the model attained an AUROC of 0.973, an AUPRC of 0.971, and an F1 score of 0.921. As a new approach to addressing label noise in medical image analysis, the proposed model has shown superiority compared to the original TRAM, Confusion Estimation, and mean-aggregated label training. The overall findings highlight the effectiveness of the proposed methods in addressing label noise in CXRs for ARDS detection, with potential for use in other medical imaging domains that encounter similar challenges.
Keywords: acute respiratory distress syndrome; chest X-ray; label noise; label uncertainty; learning using privileged information.